The fatality of medical misinformation

CHENNAI: Loganayaki (27) of Krishnagiri died recently due to severe blood loss while delivering her baby. She and her husband had attempted a natural birth at home using a technique he had watched innumerable times on YouTube.

At-home births are not common but neither are they dangerous as long as you have a trained professional helping you through it. But that’s the opposite of what transpired at Loganayaki’s house.

Throughout her pregnancy, her husband watched YouTube channels on conducting home deliveries. Confident in his ability to assist her during delivery, she had agreed to opt for home delivery sans refused medical care.

Loganayaki had also refused to consume iron tablets given to women during pregnancy, and had told her neighbours that she would eat leafy vegetables instead. She died due to severe blood loss because the umbilical cord was not cut off after the delivery.

In another instance, a 26-year-old man from Jharkhand, died after consuming excessive kaner (oleander) seeds. He had consumed them based on the advice of a YouTube channel that recommended oleander seeds for relieving toothache.

While relying on medical information you read and watch online is common practice, doctors opined that the audience needs to be discerning to know the difference between misinformation and facts.

Preventable fatalities

Even in healthcare facilities, there can be complications while delivering a baby. And, even after delivery, mother and baby must be monitored.

Therefore, wanting to have an at-home delivery by the following steps based on recommendations of YouTube channels or any other online platform can be fatal.

“It’s not just one individual but there are two lives at risk. Even when referrals from Primary Health Centres come to us, medical complications, often life-threatening, are a given.

Some women might need a caesarean or there can be post-delivery complications such as heavy bleeding and others. No online channel can assist you with that,” said Dr S Perumal Pillai, president, Legal Coordination Committee for Government Doctors.

He added that such fatalities were preventable especially considering that the State Health Department was aiming to reduce maternal deaths in the State.

“These incidents of water deliveries or at-home deliveries, sans medical supervision, are dangerous. Online information cannot be blocked; so, we must educate people about the correct way to follow medical procedures,” Dr Perumal stated.

A pregnant woman admitted to a hospital resorted to applying coconut oil on her stomach when she had abdominal pain instead of informing the doctors. This practice is prevalent in hospitals too but many doctors do not recommend it especially to pregnant women.

Consultant obstetrician and gynaecologist Dr Arvindh Santhosh says, “There are a lot of content creators in India who copy information from western countries but they do not realise the differences in the advancements in healthcare facilities in both settings.

We lack one-to-one care for deliveries. Though we’re continuously improving in the health sector, there is a long way to go. People come across concepts of home births or water births through these parenting counsellors or childbirth counsellors, who do not have the right qualifications for it.”

He pointed out that the qualification of such self-proclaimed experts started and ended with a weekend course on such topics. “It is wrong to give any form of pregnancy advice just by doing a few courses.

Such people cannot be punished under the law and they even cancel the doctors who call their bluff on social media or YouTube channels. Moreover, doctors are not influencers, and we don’t have the time to be picking on such influencers. We need the government authorities to have an infrastructure in place to end such practices,” he averred.

Village Health Nurses

The Tamil Nadu Medical Council has stressed on the need to keep track of all pregnancies through Village Health Nurses to ensure that home births are not attempted without medical supervision.

Doctors urged the need to educate families of expectant mothers on the lack of scientific evidence behind advice or recommendations for at-home deliveries, especially those based on digital channels.

“The message on safe medical practices should be spread through schools and colleges because there’s at least one child from every home in an educational institution.

Medical officers should go on field inspections and create awareness campaigns through local groups and organisations on online misinformation,” says Dr RVS Surendran, TN Medical Council.

He added that the wrong content and/or factual errors on different digital platforms must be reported and the government should bring out an act under the Information Technology Act to restrict the sharing of medical information and false messages.

“Unless there is a complaint under cyber crime or spreading misinformation is a punishable offence with jail time, we’ll always have these challenges. A policy level change needs to be done,” added Dr Surendran.

Organ damage

The classical example of delay in treatment due to misinformation can be found among those having diabetes.

Many people with diabetes turn to natural or herbal therapies that can promote the risk of developing short term and long term complications.

“I’ve had the misfortune of treating diabetic coma patients because they were fear-mongered into beliving the ‘side effects’ of using insulin, which is a life-saving therapeutic intervention for those with uncontrolled diabetes,” explains Dr Cyriac Abby Philips, Rajagiri Hospital, Kerala.

While digital mediums are littered with so-called experts with MBBS degrees offering advice on medication, those in the medical fraternity oppose such practices and lament over the suffering of their patients. “In specialties like cardiology, a doctor specialising in urology cannot talk about cardiac issues and offer medical solutions.

That’s unethical,” says a consultant cardiologist from Christian Medical College. “Patients choose home remedies based on what they watch online before meeting a cardiologist or any other specialist.

We get a lot of such cases here. Moreover, they go to a nearby clinic where their chest pain is treated as gastritis. This is valuable time wasted where doctors could have managed the cardiac emergency. By the time they come to a tertiary care hospital, their issue gets worse, often resulting in fatalities.”

Similarly, people with chronic hepatitis B infection looking at natural cures end up with a flare of viral hepatitis leading to liver failure. “Or, they end up coming to us months and years later with advanced liver cancer in the absence of timely intervention using safe and effective antiviral therapy,” added Dr Philips.

Home remedies are usually considered the first line of care in most Indian households. Most are considered benign, but some can negatively impact health.

Dr Philips cites the example of the continued use of fenugreek decoctions for controlling diabetes. It can also lead to thinning of the blood and risk of bleeding at skin surface or internal organs.

“Fenugreek contains natural coumarinoids that are blood thinners and can increase the risk of bleeding especially in those who are already on blood thinners including anti-platelet or anti-coagulant drugs,” he pointed out.

Similarly, the use of turmeric in large or small doses, over a period of time, along with pepper to increase its absorption, can lead to turmeric-related hepatitis which is one of the common causes for severe hepatitis globally. Many herbal remedies used at home can also counteract medicines that can either increase toxicity or reduce effectiveness.

Skin remedies

Log on to any social media platform, and there’s no way you can miss the ‘quick and easy’ home remedies for skin and hair. But are they safe?

City-based dermatologists opine that the popularity of such home remedies is bringing them a lot of business, as many visit them when those remedies result in adverse affects.

While some of these remedies have been practised for generations, people don’t know when to stop or whether it would suit their specific skin or scalp.

“We see a lot of patients with skin burns after applying a combo of baking soda and lemon, and also using chemical peels at home. They have no idea that these peels cannot be applied without a dermatologist’s supervision. So they suffer second-degree burns,” stated consultant dermatologist Dr Monisha Aravind, Armoraa Skin Solutions.

Cosmetic procedures like using derma rollers for micro-needling, and IV injection for skin and hair growth should not be done at home or at a non-medical set up.

“But people watch YouTube channels and try them at home, and many do not know when to stop. Micro-needling is not supposed to be done every day, as it would cause permanent damage to the skin,” she added.

Though advanced laser procedures are now available in home settings, dermatologists warn against it, because a home is not a sterile setting. And so, it can lead to many infections.

“We have to educate the people because it will take time to work on the policy level. Don’t fall for low budget remedies and risk your health. Indian Association for Dermatologists, Venereology and Leprosy is working to bring about a change in this regard,” said Dr Monisha.

Need a law

Several doctors recall cases of poisoning due to home remedies as some of these can contain heavy steroids and lead to renal damage.

“There was some form of powder being sold claiming that it will help with wheezing. A middle-aged man had a severe allergy after consuming it and passed away because of it,” says Dr Shanmugakani, Director of Medical and Rural Health Services.

“In most cases, we’ll never know if the kidney damage or failure is because of home remedies and end up on dialysis. Only after analysing the history of the patient, we realise that they have been on such remedies.”

She added that a strong law is need-of-the-hour to punish the accused with non-bailable charges. “Ban these YouTube channels,” she fumed.

Dr Abby opined that misinformation about medical procedures and remedies is like a strong current of water that flows around obstacles.

“Creating more obstacles would not help in the long term. But strongly formulated policies aimed at educating people on identifying credible sources and consistent and persistent attempts at disarming misinformation at every opportunity – from regulatory bodies or science-communicators would turn out pertinent in this battle against misinformation,” he added.

“Fighting misinformation is a scientifically progressive society’s duty starting from personal to finally a group-based persistent attempt.”

Will remove content that disputes existing health issues

The popular Google-owned video streaming platform was a haven for many content creators to post misleading or inaccurate information for views. To protect users from this harmful content, YouTube has begun removing videos that promote medical misinformation.

YouTube said that its basic framework will streamline the medical misinformation guidelines under 3 categories – prevention, treatment and denial. “These policies will apply to specific health conditions, treatments, and substances where content contradicts local health authorities or the World Health Organization (WHO),” said YouTube in a blog post in August this year.

Under denial of misinformation, YouTube said that it would remove content that disputed the existence of specific health conditions. “This covers content that denies people have died from COVID-19,” the blog said.